I have been following this site for several months and am very impressed with the knowledge of its members as well as the strength and courage exhibited by those whose PC has advanced. I’m an active 76 year old who was able to walk 2,395 miles and play 204 rounds of golf in 2018 and am fortunate to have a significantly younger lady in my life.
A brief history- gleason 7, PSA 3.2 in 2007.
Proton beam 2008. PSA .1 until 12/2016 .-
PSA 2.7. 1/2017- Bone scan and MRI of prostate negative.
PSA 10.2 - 9/2017 - Ga-68 PSMA PET/CT at UCSF showed hot spot in left seminal vesicle.
11/17 Transperineal biopsy (30 samples) of prostate and both seminal vesicles. All samples negative.
3/18 - PSA 11.7 Feraheme MRI of lymph nodes- negative.
6/18 - PSA 19.6 Axumen PET/CT scan - negative.
9/18 - PSA 24.5 1st appointment with M O at OHSU - continue watchful waiting.
12/18 -PSA 34.8 - Axumin PET/CT scan negative.
1/15/19 - 2nd appointment with M O
My dilemma: I am experiencing a sharply rising PSA meaning that the cancer has likely returned. But we are unable to find it and have no specific target. Is it time for some form of ADT? Quality of life is very important to me. But I don’t want to take undue risk. Looking for recommendations. Also, any courses of action besides watchful waiting or ADT? THANKS!
You found it in the seminal vesicles. They are squiggly (a technical term! lol) and extremely difficult to biopsy. Salvage HDR brachytherapy (which should be available at UCSF) may be able to get the rest of it. Alternatively, salvage whole gland SBRT is available in a clinical trial at NIH or by Don Feller in San Diego. Here are the options:
Before you start on adjuvant ADT, you might wish to ask for a circulating tumor cell analysis from CellSearch. If they find 5 or more, your cancer may be systemic and micrometastatic - in which case, salvage therapy is probably of no benefit.
Wow, tall guy you are an endless found of info.